Pulse oximetry in diagnosis of paediatric obstructive sleep apnoea-adding value with heart rate analysis

Abstract

Introduction and rationale: Level 4 studies predominantly rely on saturation profile for analysis. There is additional data on heart rate that is available with this signal which could potentially help in augmenting the respiratory accuracy. Arousals are associated with an increase in sympathetic activity and can therefore be detected by studying the changes in heart rate pattern. Objectives: To evaluate the impact of adding heart rate analysis to the oximetry data in diagnosis of OSA and comparing it to the gold standard PSG diagnosis and diagnosis based on McGill oximetry score. Methods: 90 sleep studies of children between 1 and 8 years with suspected OSA were chosen and divided into three groups based on AHI; Normal study (AHI <1/hr), mild & moderate OSA (AHI 1-10/hr) and severe OSA (AHI >10/hr). The Oximetry information from PSG was extracted to reflect oximetry download. Pulse rate rises at different increase, 5-45 from baseline were scored automatically with conventional software. The diagnostic accuracy of McGill and heart rate events [HRE] were correlated with PSG report to determine the accuracy of diagnosis of OSA using the single and dual channels. Results: There was significant difference in pulse rate surges between the three groups. The diagnostic accuracy of McGill score in comparison to PSG is 36.7% for mild to moderate OSA and 76.7% for severe OSA. Combining Mc Gill score with pulse rate surge >5 at threshold >72 surges/hr increased the sensitivity of detecting mild to moderate OSA in oximetry from 36.7% to 77%, while diagnosis of severe OSA increased from 76.7% to 86.7%. Combining pulse rate surge >10 at threshold of 33 surges/hr also showed similar results with increased sensitivity of detecting mild to moderate OSA from 36.7% to 70% and severe OSA from 76.7% to 90%. Conclusions: Adding heart rate analysis is feasible and readily done with the oximetry download data. Combining Mc Gill score and pulse rate surges at >5 with a threshold of >72/hr and >10 with a threshold of >33/hr can increase the diagnostic accuracy of OSA on oximetry.L6246120342018-11-01 <br />